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638 From physical activity to exercise training
Results: Data are presented as relative changes from baseline. Pre-PCI, home-
based exercise training decreased circulating VEGF-levels in the ex group (-
7+12%), while in the ctrl group VEGF-levels were increased (9+21%), p<0,005.
There was a non-significant increase in SDF-1 levels in ctr l patients, as compared
to ex patients, where the levels remained unchanged (3+9% non-ex 0+9% ex,
p=0,06). In the ctrl group the increased VEGF-levels seen pre-PCI were seen to
gradually normalize to baseline levels after PCI, while in the ex group PCI did not
seem to have any additional effect (at 3 months 4+21% ctrl, -4+19% ex, p=<0,05,
at 6 months, 0+21% ctrl, -5+19% ex, NS). PCI did not affect SDF-1 levels neither
in controls nor in exercised individuals (at 3 months 2+9% ctrl, 3+10%, ex, p=NS
and at 6 months 3+12% ctrl, 2+18% ex, NS). Neither exercise nor PCI affected
levels of NT-proBNP, TNT or copeptin.
Conclusions: Exercise training in patients with stable coronary artery disease
decreases circulat ing angiogenic cytokines, possibly due t o a decreased ischemic
burden. PCI decreases levels of VEGF in non-trained individuals, while in exer-
cise trained individuals, it provides no additional effect. SDF-1 was not affected by
PCI. Exercise in patients with stable coronary artery disease does not increase
markers of cardiac dysfunction, suggesting that it is a safe therapeutic interven-
tion in these patients.
P3394 | BEDSIDE
Prognostic implications of physical activity and health status
related questionnaires in adult patients with congenital heart
disease
A. Frogoudaki1, C. Andreou2, J. Parissis1, C. Maniotis2, E. Koutsotheodorou1,
M. Nikolaou1,I.Rizos
1, G. Filippatos 1, M. Anastasiou-Nana1.
1
Second
Cardiology Department, Athens University, ATTIKON University Hospital, Athens,
Greece;
2
Red Cross Hospital, Department of Cardiology, Athens, Greece
Aim: Impaired health status is a common clinical condition i npatients with chronic
heart failure. This study investigates the prognostic value of Duke Activity Status
Index (DASI) and Living with Heart Failure Minnesota Questionnaire (MLHF) in
adult patients with congenital hear t disease.
Methods: From our database, we studied 70 consecutive patients (33 men, mean
age 30 years±14 years) with congenital heart disease. Patients had simple car-
diac lesions or complex cardiac lesions (no cyanosis) or were cyanotic. Patients
answered questionnaires of physical activity (DASI) and quality of life (MLHF).
They were monitored for long-term major cardiovascular events: cardiovascular
death, hospitalization due to cardiovascular cause, NYHA class worsening, new
onset of arrhythmias, surgical or percutaneous intervention.
Results: DASI median value was 50.7 (25th perc= 36.5, 75th perc=58.2) and
MLHF 13 (25th perc= 3,
75th perc=30.5). Patients were followed for 629±360 days. During the follow-up
period, 4 patients died, 9 underwent intervention, 7 were hospitalized for cardio-
vascular reasons, 4 deteriorated clinically and 6 presented with new onset ven-
tricular or supraventricular arrhythmias.
Multivariate analysis showed that higher DASI value was predictor of better
outcomes concerning all major cardiovascular events (HR=0.968, CI=0.940-
0.997, p=0.029), hospitalization due to cardiovascular reason (HR=0.956
CI=0.925-0.988 p=0.008) and NYHA class worsening (HR=0.920, CI=0.847-
1.000, p=0.049).
Finally, MLHF value significantly predicted all major cardiovascular events
(HR=1.033, CI=1.012-1.054, p=0.002), hospitalization for cardiovascular reason
(HR=1.048, CI=1.022-1.074, p=0.0002) and NYHA class worsening (HR=1.064,
CI=1.001-1.130, p=0.045).
Conclusion: Calculation of DASI and MLHF questionnaires is a very simple and
easily approached strategy that may have important prognostic value in adult
patients with congenital heart disease
P3395 | BENCH
Increased physical activity prevents the progress of
arteriosclerosis by reducing advanced glycation end products and
oxidative stress in patients with diabetes mellitus, hypertension,
and/or dyslipid
Y. Kamada1,S.Ito
2,D.Kamekawa
1, M. Katagiri 1,H.Ishii
1, K. Hotta1,
S. Yamamoto1,K.Kamiya
1,C.Noda
3, T. Masuda2.
1
Kitasato University,
Graduate School of Medical Sciences, Sagamihara, Japan;
2
Kitasato University,
School of Allied Health Sciences, Department of Rehabilitation, Sagamihara,
Japan;
3
Kitasato University, School of Medicine, Department of Emergency and
Critical Care Medicine, Sagamihara, Japan
Background: Hyperglycemia or augmented oxidative stress is known to promote
the production of advanced glycation end products (AGEs) in patients with di-
abetes mellitus (DM), hypertension (HT) and/or dyslipidemia (DL). AGEs accu-
mulate in vessels and cause the improper increase of arterial stiffness. Although
increased physical activity (PA) reduces inflammatory cytokines and free oxygen
species, it is unclear whether increased PA inhibits the AGEs production and de-
creases the arterial stiffness in them. The aim of this study was to investigate the
effects of PA on the increase of arterial stiffness promoted by AGEs and oxidative
stress.
Methods: In 51 outpatients with DM, HT and/or DL, AGEs and oxidative
stress were assessed by serum pentosidine and malondialdehyde-modified LDL-
cholesterol (MDA-LDL), respectively. The PA and arteriosclerosis were eval-
uated by daily steps using an accelerometer and intima-media thickness of
carotid arter y (IMT), respectively. Functional arterial stiffness was assessed by
the change of brachial-ankle pulse wave velocity (PWV) before and after a cy-
cle ergometer exercise performed at moderate intensity (PWV). Patients were
divided into two groups based on the median of daily steps: high PA and low
PA groups. We compared pentosidine, MDA-LDL, IMT and PWV between the
two groups and analyzed the relationships among daily steps, pentosidine and
PWV.
Results: Pentosidine, MDA-LDL, IMT and PWV were significantly lower in the
high PA group than in the low PA group (P<0.05, respectively). Pentosidine was
negatively correlated with daily steps (Figure 1). The PWV was positively corre-
lated pentosidine (Figure 2).
Relationship among PA, AGEs and PWV
Conclusion: Increased PA suppressed the improper increase of arterial stiffness
by reducing AGEs and oxidative stress in patients with DM, HT, and/or DL.
P3396 | BENCH
Habitual physical activity seems to be related with higher serum
testosterone levels and improved insulin resistance in elderly
diabetic individuals: IKARIA study
C. Chrysohoou, C. Pitsavos, G. Siasos, M. Zaromytidou, V. Metaxa,
N. Galiatsatos, E. Christoforatou, K. Dimitriadis, E. Kambaxis, C. Stefanadis.
University of Athens, Athens, Greece
Background: Diabetes mellitus induce several structural and functional changes
in cardiovascular system. Physical activity has shown beneficial effects on pri-
mary and secondary prevention of cardiovascular (CVD) diseases due to the im-
provement of mechanical properties of the arteries, the muscle tone and neuro-
hormonal activation; although those effects have not been evaluated in elderly
population with increased cardiovascular risk. In this study we aimed to evaluate
the effect of a habitual physical activity on metabolic profile and testosterone lev-
els in seniors diabetic individuals, inhabitants of Ikaria Island, a place with high
longevity rates.
Methods: We enrolled 752 individuals aged 65 to 100 years, permanent in-
habitants of Ikaria Island, (49% men, mean age 77±8). Among several socio-
demographic, bioclinical, lifestyle and dietary characteristics, CVD factors, physi-
cal activity status was evaluated IPAQ, total serum testosterone levels were mea-
sured and HOMA-IR was calculated for the evaluation for insulin resistance.
Results: 221 subjects (55% males, mean age 76±6) were defined as diabetics
according to their history and fast blood glucose levels. Those physically active
were younger, less obese, less hypertensive, showed higher rates of hypercholes-
terolemia, smoking habits, lower prevalence of cardiovascular disease, higher
total testosterone levels and lower HOMA (all p<0.05); while they showed no
significant difference on LDL/HDL ratio creatinine clearance and nutrition habits.
Linear regression analysis revealed that physical activity status was inversely re-
lated to HOMA levels (B=-2,268±0.758, p=0.03), after adjustment was made for
age, gender, hypercholesterolaemia, obesity, hypertension and hours night sleep.
Furthermore, physical activity status was inversely related to serum testosterone
levels (p=0.05), after the same adjustment were made, only in men.
Conclusions: Long term adherence to a physically lifestyle seems to mediate the
adverse effect of diabetes mellitus on cardiovascular risk in elderly individuals,
improving insulin resistance and serum testosterone levels. Those results may
partly explain the link between lifestyle habits with longevity.
P3397 | SPOTLIGHT 2013
Visceral fat mass is associated with daily physical activity, leg
skeletal muscle mass and fiber intake in healthy men
K. Nishikawa1, S. Yagi2,T.Ise
2, Y. Ueda2,I.Iwase
2,M.Akaike
3,
M. Shimabukuro3,S.Kato
1,M.Sata
2.
1
Tokushima University Hospital, Division
of Rehabilitation, Tokushima,
2
University of Tokushima Graduate School, IHBS,
Department of Cardiovascular Medicine, Tokushima,
3
University of Tokushima
Graduate School, Institute of Health Biosciences (IHBS), Tokushima, Japan
Background: Inappropriate food intake and decrease in physical activity can lead
to metabolic syndrome, which is represented by accumulation of vi sceral fat. How-
ever, it has not been unknown what quantity and quality of food intake and physi-
cal activity is associated with accumulation of visceral fat.
by guest on October 26, 2015http://eurheartj.oxfordjournals.org/Downloaded from
From physical activity to exercise training 639
Methods: Sixty-seven healthy men (mean age, 36.8±8.7 yrs)were enrolled in this
study. Visceral fat area (VFA) was measured with fat area analyzer, and skeletal
muscle mass was measured with a body composition analyzer. Dail y intake levels
of nutrition factors, including calories, protein, lipid, carbohydrates, salt, n-3 fatty
acid, vitamin D, and fiber, that are known to reduce VFA were calculated from
questionnaires. Physical activity energy expenditure (PAEE) and total energy ex-
penditure (TEE) were also calculated from the questionnaires.
Results: Mean VFA was 73.4±28.4 cm2. Univariate analysis showed that VFA
was inversely associated with age (P<0.01), skeletal muscle mass (P<0.01), TE E
(P<0.01), and PAEE (P<0.05). VFA was associated with fiber intake (P<0.01)
but not with intake of calories, protein, lipid, carbohydrates, salt, n-3 fatty acid,
and vitamin D. Multivariate analysis showed that skelet al muscle mass, especially
leg muscle mass (coefficient:- 7.9, 95% CI: -10.7 to -5.5, p<0.01), fiber intake
(coefficient: -0.7, 95% CI: -1.34 to -0.052, p<0.05), and TEE (coefficient: -0.3,
95% CI: -0.51 to -0.023, p<0.05) were negative independent determinants of
VFA and that age (coefficient:0.79, 95% CI 0.44 to 1.15, p<0.01) was a positive
independent determinant of VFA.
Conclusion: Increases in physical activity, muscles mass, especially leg muscle
mass, and fiber intake were shown to be associated with decreased VFA, sug-
gesting that daily exercise using the legs and increased intake of fiber such as
fiber from vegetables prevent metabolic syndrome through decreasing VFA.
P3398 | SPOTLIGHT 2013
The role of intradialytic aerobic training in improved functional
capacity and cognitive function in patients with chronic kidney
disease on hemodialysis
F. Stringuetta-Belik, V.R.O. Silva, F.G. Shirashi, R.S. Goncalves, P. Barretti,
J.C.T. Caramori, L.C. Martin, R.J.S. Franco.
Univ. Estadual Paulista (UNESP),
Botucatu Medical School - Sao Paulo State University, Botucatu, Brazil
Objective: To evaluate the effect of intradialytic aerobic training on functional and
cognitive function in patients with chronic kidney disease (CKD) on hemodialysis
(HD).
Methods: We selected eight patients on HD Facility. We conducted an exercise
test (Bruce protocol) on a treadmill to exclude patients with coronary artery dis-
ease, obtain the values of maximum heart rate (MHR) and assess aerobic capac-
ity through the maximum volume of oxygen consumption (VO2max) estimated.
Patients were tested for 6-minute walk (6MWT) to assess functional capacity.
For screening cognitive function, patients answered the instrument Mini Mental
State Examination (MMSE). The ability patients were included in a protocol with
intradialytic aerobic training on a cycle ergometer. The exercise was conducted
during the first hour of the HD session, 30 minutes, three times a week for four
months. Was used the 65-75% of maximum hear t rate training range, controlled
by frequency heart counter FS2 Polar. All assessments were repeated at the end
of the training program. "T" test was applied and the results were presented as
mean ±SD.
Results: The results showed an improvement in aerobic capacity (p = 0.03), ac-
companied by improved functional capacity (p = 0.02) and cognitive function (p =
0.01).
Characteristics of patients
Before protocol (n=8) After protocol (n=8) p
Age (years) 45±16.48 45±16.29 0.08
BMI (kg/height2) 24.4±6.99 24.3±6.75 0.31
VO2max (ml/kg/min) 28.2±12.80 33.7±9.84 0.03
6MWT (m) 564.2±71.16 648.5±53.21 0.02
Cognitive Function (MMSE’s point) 23.7±2.66 26.3±3.54 0.01
Creatinine (mg/dl) 8.3±2.24 9.7±2.20 0.09
Hemoglobin (g/dl) 11.2±0.45 12.8±1.48 0.04
BMI, body mass index; VO2max, maximum volume of oxygen consumption; 6MWT, six minutes
walk test; MMSE, Mini Mental State Examination.
Conclusion: We found that intradialitic aerobic training has a beneficial effect on
functional and cognitive function in CKD patients on HD. FAPESP 2011/20652-7.
P3399 | BENCH
Effects of exercise training on adrenergic and cholinergic
responses of rabbit carotid artery
M.D. Mauricio1, L. Brines Ferrando2, M. Aldasoro1,G.Parra
2,P.Marchio
1,
N. Gallego1,C.Soler
1, L. Such-Miquel 3,J.M.Vila
1.
1
University of Valencia,
Department of Physiology, Valencia, Spain;
2
University of Valencia. Department
of Physiology. INCLIVA, Valencia, Spain;
3
University of Valencia, Department of
Physiotherapy, Valencia, Spain
Purpose: Physical activity is able to reduce cardiovascular morbidity and mortal-
ity. These effects may be mediated in a number of ways including an enhance-
ment of endothelial function. We investigated the effects of physical training on
plasma levels of nitric oxide (NO) and vascular responses induced by sympa-
thetic stimulation and acetylcholine.
Methods: Eleven male New Zealand white rabbits were exercised during 6 weeks
following a chronic exercise protocol on treadmill (trained group) and another
twelve rabbits (control group) were stabulated during the same period. When
the chronic exercise program was finished, rabbits were anaesthetized, killed
and common carotid arteries were dissected. Arterial segments (3 mm long)
were mounted for isometric recording of tension in organ baths containing Krebs-
Henseleit solution. Electrical field stimulation (EFS, 4Hz, 20V, 0.25 ms duration
for 30 s) was provided by a Grass S88 stimulator via two platinum electrodes
positioned on each side and parallel to the axis of the arterial segment. Blood
samples were drawn from the ear artery before anaesthesia for determination of
plasma nitrite plus nitrate (NOx) using the Griess reaction.
Results: Acetylcholine (3x10-6M) produced more relaxation in control group
(Emax values: 93.8±2.1 for control group vs 83.5±3.2 for training group, n=10;
p>0.05). The NOS inhibitor NG-nitro-L-arginine methyl ester (L-NAME 10-4M)
reduced the relaxation to acetylcholine in both trained (pD2 = 6.7±0.2, n=5;
p<0.001) and control rabbits (pD2 = 6.9±0.2, n=5; p<0.001). The reduction
of maximum effect by L-NAME was greater in control rabbits (44% vs 34%,
p<0.05). The contractile responses to EFS were abolished by tetrodotoxin (10-
6M), guanethidine (10-6M) and prazosin (10-6M) thus indicating that the contrac-
tile effect is due to noradrenaline acting on a1 adrenoceptors. EFS (1, 2 and 4 Hz)
induced contraction was greater in trained groups. L-NAME 10-4M enhanced the
contractions elicited by EFS in both groups with the similar magnitude. Plasma
levels of NOx were similar in both control and trained groups (67±21 mM vs
62±20 mM, n=11; p>0.05).
Conclusions: Although NO plasma levels were similar in the two groups, trained
rabbits show a significant decrease in the NO component, sensitive to L-NAME,
induced by acetylcholine but not by sympathetic stimulation.
P3400 | SPOTLIGHT 2013
Inspiratory loaded exercises improve cardiovascular vagal
modulation and barorreflex sensitivity in subjects with
hypertension
J. Ferreira1,C.Mostarda
1, P. Dal Lago2, F. Santos1, F. Consolim-Colombo1,
M.C. Irigoyen1.
1
Heart Institute, University of São Paulo Medical School, São
Paulo, Brazil;
2
Federal University of Health Sciences of Porto Alegre, Porto
Alegre, Brazil
Purposes: Inspiratory muscle training (IMT) protocols have beneficial effects on
autonomic cardiovascular control in hypertensive subjects, decreasing sympa-
thetic and increasing parasympathetic cardiovascular modulation. Nevertheless,
the behavior of autonomic cardiovascular control after one single session of IMT
is not completely understood. So, this study intends to show the effects of one
single session of inspiratory loaded exercise (ILE) on cardiovascular autonomic
modulation and barorreflex sensitivity in hypertensive patients.
Methods: Patients with controlled hypertension with no inspiratory muscle weak-
ness were enrolled to undergo a 30 min inspiratory loaded exercise session with a
load of 30%PImax, using PowerBreathe®device. Respiratory evaluation of mus-
cle strength (PImax: maximum inspirator y pressure) was performed with an elec-
tronic pressure manometer by manovacuometry. Respiratory rhythm was moni-
tored by a respiratory belt sensor. Blood pressure and heart rate were monitored
by beat to beat recording system before (10 min) and one hour after the session
(10 min). Autonomic cardiovascular responses and spontaneous barorreflex sen-
sitivity were evaluated, respectively, by autoregressive spectral analysis and the
sequence method, and analyzed by Student t test.
Results: Seven hypertensive subjects (4 male) were enrolled to the study (mean
age 55.86±7.93 yrs, PImax 80.14±36.09cmH2O, systolic blood pressure (SBP)
139.86±13.93mmHg and dyastolic blood pressure (DBP) 82.71±10.14mmHg.
All participants performed the ILE with no complaining nor symptoms. Analyz-
ing the heart rate variability one hour after the session, we observed increased
heart rate variance (1924.42±1914.27 vs 3068.59±2510.26; p=0.006), increase
of vagal modulation (RMSSD:37.29±17.87 vs 53.13±24.19, p=0.01) and sym-
pathetic modulation (LF n.u.: 693.47±843.53 vs 934.99±949.79, p=0.02), with
no change in sympatho-vagal balance. Thus, it was observed an improvement in
spontaneous barorreflex sensitivity with only one ILE session (BRR down gain:
14.06±6.75 vs 18.44±8.11, p=0.01). Even though, we did not notice changes in
peripheral sympathetic modulation nor in blood pressure and heart rate levels.
Conclusions: We demonstrated for the first time that one single session of an
IMT program is able to alter some components of heart rate variability, improving
autonomic cardiovascular control and spontaneous barorreflex sensitivity in pa-
tients with essential hypertension. These data can lead to new findings regarding
the beneficial effects of IMT in hypertension.
P3401 | BEDSIDE
Predictive value of noninvasive markers of atherosclerosis for
cardiovascular morbidity and mortality in patients with coronary
artery disease (4 years follow-up study)
S. Kostic1,I.Tasic
2, D. Djordjevic2,T.Savic
2,D.Lovic
3, D. Mijalkovic4.
1
Institute
for Therapy & Rehabilitation "Niska Banja", Niska Banja, Nis, Serbia;
2
University
of Nis, Medical Faculty, Nis, Serbia;
3
Clinic for internal disease InterMedica-dr
Lovic, Nis, Serbia;
4
Clinic for internal disease "Kardiomedika", Nis, Serbia
Ankle brachial pressure index (ABI) and carotid artery intima-media thickness
(CIMT) and the are non-invasive markers of atherosclerosis and have been shown
to reliably predict presence atherosclerotic vascular disease.
Purpose: The objective of this study was to examine predictive value of ABI and
carotid IMT for cardiovascular morbidity and mortality.
by guest on October 26, 2015http://eurheartj.oxfordjournals.org/Downloaded from